Surgical tool systems and method

ABSTRACT

Embodiments of the invention provide a guided surgical tool assembly with a guide tube including a sensor, a surgical instrument including a detectable feature moveable within the guide tube, and the sensor capable of detecting the detectable feature when the surgical instrument is inserted in the guide tube. Some embodiments include a sensor pad, a guide stop coupled to the surgical instrument, a plunger mechanism including a compressible spring mechanism coupled to the guide tube, and a wiper capable of being sensed by the sensor pad. Some embodiments include a guided surgical tool assembly system comprising a tool sensor system including a processor and at least one data input/output interface. Some embodiments include a medical robot system with a guided surgical tool assembly and including a robot coupled to an effectuator element configured for controlled movement and positioning along one or more of an x-axis, a y-axis, and a z-axis.

RELATED APPLICATIONS

This application claims priority under 35 U.S.C. §120 to U.S. patentapplication Ser. No. 13/924,505 filed on Jun. 21, 2013, which claims thepriority 35 U.S.C. §119 to U.S. Provisional Patent Application No.61/662,702 filed on Jun. 21, 2012 and U.S. Provisional PatentApplication No. 61/800,527 filed on Mar. 15, 2013, each of which areincorporated herein by reference in their entirety.

BACKGROUND

Various medical procedures require the accurate localization of athree-dimensional position of a surgical instrument within the body inorder to effect optimized treatment. For example, some surgicalprocedures to fuse vertebrae require that a surgeon drill multiple holesinto the bone structure at specific locations. To achieve high levels ofmechanical integrity in the fusing system, and to balance the forcescreated in the bone structure, it is necessary that the holes aredrilled at the correct location. Vertebrae, like most bone structures,have complex shapes including non-planar curved surfaces making accurateand perpendicular drilling difficult. Conventionally, a surgeon manuallyholds and positions a drill guide tube by using a guidance system tooverlay the drill tube's position onto a three dimensional image of thebone structure. This manual process is both tedious and time consuming.The success of the surgery is largely dependent upon the dexterity ofthe surgeon who performs it.

Limited robotic assistance for surgical procedures is currentlyavailable. For example, the da Vinci® medical robot system (da Vinci® isa registered trademark of Intuitive Surgical) is a robot used in certainsurgical applications. In the da Vinci® system, the user controlsmanipulators that control a robotic actuator. The system converts thesurgeon's gross movements into micro-movements of the robotic actuator.Although the da Vinci® system eliminates hand tremor and provides theuser with the ability to work through a small opening, like many of therobots commercially available today, it is expensive, obtrusive, and thesetup is cumbersome. Further, for procedures such as thoracolumbarpedicle screw insertion, these conventional methods are known to beerror-prone and tedious.

One of the characteristics of many of the current robots used insurgical applications which make them error prone is that autonomousmovement and precise placement of a surgical instrument can be hinderedby lack of mechanical feedback and/or loss of visual placement once theinstrument is submerged within a portion of a patient.

SUMMARY

Some embodiments of the invention provide a guided surgical toolassembly comprising a guide tube including at least one sensor and asurgical instrument including at least one detectable feature moveablewithin the guide tube. In some embodiments, the at least one sensor isconfigured and arranged to detect the at least one detectable featurewhen the surgical instrument is at least partially inserted in the guidetube.

Some embodiments include a detectable feature comprising a magneticallydetectable feature capable of generating a magnetic flux field, and insome embodiments, the sensor is a position sensor capable of detectingthe magnetic flux field. Some embodiments also include a position sensorconfigured and arranged to detect insertion into and movement of thesurgical instrument in the guide tube by sensing the magneticallydetectable feature. In some embodiments, the position sensor is amagnetic flux field sensor selected from a group consisting of aferrite-based magnetic material, a rare-earth based magnetic material,an aluminum-nickel-cobalt based magnetic material, and mixtures thereof.

In some embodiments, the detectable feature includes at least onelongitudinal magnetic strip and at least one radial magnetic strip.Further, in some embodiments, the guide tube includes at least threeposition sensors, and in some embodiments, the at least three positionsensors are configured and arranged to sense a magnetic field flux fromthe longitudinal magnetic strip or the radial magnetic field strip orboth.

In some embodiments, the longitudinal position of the surgicalinstrument in the guide tube can be at least partially determined usinga measurement of a magnetic field flux from the longitudinal magneticstrip. In other embodiments, a radial position of the surgicalinstrument in the guide tube can be at least partially determined usinga measurement of a magnetic field flux from the radial magnetic strip.

Some embodiments include a detectable feature comprising an opticallydetectable feature, and at least one sensor comprising at least oneoptical sensor. In some embodiments, the optically detectable featurecomprises a contrasting or high contrast marking distributed along atleast a partial longitudinal length of the guided surgical toolassembly.

Some embodiments include at least one optical sensor comprising a lightsensitive detector selected from a group consisting of a photodiode, aphototransistor, a fiber-optic sensor, a photo-multiplier, a CCD, acamera, or a combination thereof.

In some embodiments, the longitudinal position of the surgicalinstrument in the guide tube can be at least partially determined byoptically sensing light from the high contrast marking using the atleast one optical sensor.

Some embodiments include an optically detectable feature comprising agraduated coating distributed along at least a partial longitudinallength of the guided surgical tool assembly. In some embodiments, thegraduated coating comprises a graduated reflective coating. In otherembodiments, the graduated coating comprises a graduated color coating.

In some embodiments, the longitudinal position of the surgicalinstrument in the guide tube can be at least partially determined byoptically sensing light from the graduated coating using the at leastone optical sensor.

Some embodiments include a guided surgical tool assembly wherein theguide tube comprises a distal guide tube end and a proximal guide tubeend, and the surgical instrument includes a distal end and a proximalend. In some embodiments, the sensor comprises at least one sensor pad.The guided surgical tool assembly can further comprise a guide stopcoupled to the proximal end of the surgical instrument, and a plungermechanism. The plunger mechanism can include a compressible springmechanism coupled to the distal end of the guide tube and a wiperconfigured and arranged to be sensed by the at least one sensor pad.

In some embodiments of the guided surgical tool assembly, longitudinalmovement of the surgical instrument within the guide tube (where theguide stop moves toward the proximal end of the guide tube) can at leastpartially compress the spring and move the wiper with respect to the atleast one sensor pad. In other embodiments, longitudinal movement of thesurgical instrument within the guide tube where the guide stop movesaway from the proximal end of the guide tube can at least partiallydecompress the spring and move the wiper with respect to the at leastone sensor pad.

Some embodiments include a guided surgical tool assembly systemcomprising a tool sensor system including at least one processor and atleast one data input/output interface. In some embodiments, the datainput interface including at least one sensor, a guide tube includingthe at least one sensor, and a surgical instrument moveable within theguide tube. In some embodiments, the surgical instrument includes atleast one detectable feature, and the at least one sensor is configuredand arranged to detect the at least one detectable feature.

In some embodiments, the guided surgical tool assembly system includes aguide tube comprising a distal guide tube end and a proximal guide tubeend, and the surgical instrument includes a distal end and a proximalend. In some embodiments, the sensor comprises at least one sensor pad,and the guided surgical tool assembly further comprises a guide stopcoupled to the proximal end of the surgical instrument, the plungermechanism can include a compressible spring mechanism coupled to thedistal end of the guide tube and a wiper configured and arranged to besensed by the at least one sensor pad. The at least one processor can beconfigured and arranged to detect the at least one surgical instrumentwhen the instrument at least partially inserted or moved in the guidetube.

In some embodiments of the guided surgical tool assembly system, thedetectable feature comprises a magnetically detectable feature capableof generating a magnetic flux field. The sensor can be a position sensorcapable of detecting the magnetic flux field, and be configured andarranged to detect insertion into and movement of the surgicalinstrument in the guide tube by sensing the magnetically detectablefeature.

Some embodiments include a guided surgical tool assembly system in whichthe detectable feature comprises an optically detectable feature, andthe at least one sensor comprises at least one optical sensor. Theoptically detectable feature can comprise a contrasting or high contrastmarking distributed along at least a partial longitudinal length of theguided surgical tool assembly. In some embodiments, the detectablefeature comprises an optically detectable feature, and the at least onesensor comprises at least one optical sensor. The optically detectablefeature can comprise a graduated coating distributed along at least apartial longitudinal length of the guided surgical tool assembly.

Some embodiments include a medical robot system comprising a robotcoupled to an effectuator element configured for controlled movement andpositioning, and a motor assembly coupled to the robot. The motorassembly can be configured to move the effectuator element along one ormore of an x-axis, a y-axis, and a z-axis such that movement of theeffectuator element along one of the x-, y-, or z-axes occursindependently of movement of the effectuator element along the otheraxes of the x-, y-, and z-axes, wherein the x-axis is substantiallyperpendicular to the y- and z-axes, the y-axis is substantiallyperpendicular to the x- and z-axes, and the z-axis is substantiallyperpendicular to the x- and y axes.

In some embodiments, the medical robot system also comprises a toolsensor system including at least one processor and at least one datainput/output interface, the data input interface including at least onesensor, and a guide tube including the at least one sensor. In someembodiments, the surgical instrument is moveable within the guide tube,and the surgical instrument includes at least one detectable feature.Further, in some embodiments, the at least one sensor is configured andarranged to detect the at least one detectable feature, and the at leastone processor is configured and arranged to detect when the surgicalinstrument is at least partially inserted in the guide tube. In someembodiments, the detectable feature can include one or more ofinstrument length, type, torque ranges, depth of treatment parametersand other instrument parameters. Some embodiments include a trackingmarker coupled to the surgical instrument.

DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1B illustrate a surgical robot in accordance with oneembodiment of the invention.

FIG. 1C illustrates a portion of a surgical robot with control of thetranslation and orientation of the end-effectuator in accordance withanother embodiment of the invention.

FIG. 1D illustrates a partial view of a surgical robot having aplurality of optical markers mounted for calibration and trackingmovement in accordance with one embodiment of the invention.

FIG. 2 illustrates a surgical robot operating on a patient in accordancewith one embodiment of the invention.

FIGS. 3A-3B each illustrates a tool assembly including a surgicalinstrument having a guide stop mechanism in accordance with oneembodiment of the invention.

FIGS. 4A-4D each depict a tool assembly including a surgical instrumenthaving a guide stop mechanism in accordance with one embodiment of theinvention.

FIGS. 5A-5C each illustrates tools for manually adjusting a drill stopwith reference to drill bit markings in accordance with one embodimentof the invention.

FIGS. 5D-5F each illustrates tools for locking and holding a drill bitin a set position in accordance with one embodiment of the invention.

FIGS. 5G-5H each illustrates methods of use of the tools as depicted inFIGS. 5A-5F with a robot end effectuator coupled to a robot system.

FIG. 6A illustrates a tool assembly including a surgical instrumenthaving a sensor enabled guide stop mechanism in accordance with oneembodiment of the invention.

FIG. 6B illustrates a tool assembly system architecture in accordancewith one embodiment of the invention.

FIG. 7A illustrates a tool comprising a surgical instrument having aguide stop mechanism in accordance with another embodiment of theinvention.

FIG. 7B is a modified guide tube for use with the tool assembly shown inFIG. 7C in accordance with one embodiment of the invention.

FIG. 7C shows the tool shown in FIG. 7A inserted within the modifiedguide tube shown in FIG. 7B to form a tool assembly in accordance withone embodiment of the invention.

FIG. 8A illustrates a tool assembly including a surgical instrumenthaving a guide stop mechanism in accordance with another embodiment ofthe invention.

FIG. 8B illustrates a tool assembly including a surgical instrumenthaving a guide stop inserted within a modified guide tube in accordancewith another embodiment of the invention.

FIG. 9 illustrates a tool assembly including a surgical instrumenthaving a guide stop inserted within a modified guide tube in accordancewith another embodiment of the invention.

FIG. 10 illustrates a tool assembly including a surgical instrumenthaving at least one tracking marker in accordance with a furtherembodiment of the invention.

DETAILED DESCRIPTION

Before any embodiments of the invention are explained in detail, it isto be understood that the invention is not limited in its application tothe details of construction and the arrangement of components set forthin the following description or illustrated in the following drawings.The invention is capable of other embodiments and of being practiced orof being carried out in various ways. Also, it is to be understood thatthe phraseology and terminology used herein is for the purpose ofdescription and should not be regarded as limiting. The use of“including,” “comprising,” or “having” and variations thereof herein ismeant to encompass the items listed thereafter and equivalents thereofas well as additional items. Unless specified or limited otherwise, theterms “mounted,” “connected,” “supported,” and “coupled” and variationsthereof are used broadly and encompass both direct and indirectmountings, connections, supports, and couplings. Further, “connected”and “coupled” are not restricted to physical or mechanical connectionsor couplings.

The following discussion is presented to enable a person skilled in theart to make and use embodiments of the invention. Various modificationsto the illustrated embodiments will be readily apparent to those skilledin the art, and the generic principles herein can be applied to otherembodiments and applications without departing from embodiments of theinvention. Thus, embodiments of the invention are not intended to belimited to embodiments shown, but are to be accorded the widest scopeconsistent with the principles and features disclosed herein. Thefollowing detailed description is to be read with reference to thefigures, in which like elements in different figures have like referencenumerals. The figures, which are not necessarily to scale, depictselected embodiments and are not intended to limit the scope ofembodiments of the invention. Skilled artisans will recognize theexamples provided herein have many useful alternatives and fall withinthe scope of embodiments of the invention.

FIGS. 1A-1B illustrate a surgical robot system 1 in accordance with oneembodiment of the invention, and FIG. 1C illustrates a portion of asurgical robot system 1 with control of the translation and orientationof the end-effectuator in accordance with another embodiment of theinvention. Referring now to FIGS. 1A-1B, some embodiments include asurgical robot system 1. As shown, in some embodiments, the surgicalrobot 15 can comprise a display 29 and a housing 27. In someembodiments, the display 29 can be attached to the surgical robot 15. Inother embodiments, a display 29 can be detached from surgical robot 15,either within a surgical room with the surgical robot 15, or in a remotelocation. In some embodiments, the housing 27 can comprise a robot arm23, and an end-effectuator 30 coupled to the robot arm 23 controlled byat least one conventional motor. In some embodiments, theend-effectuator 30 can comprise an instrument used to perform surgery ona patient 18 (such as for example the surgical instrument 35 depicted inFIGS. 3A-3B, 4A-4D, 6A, 7A, 7C, 8A-8B, 9 and 10). In other embodiments,the end-effectuator 30 can be coupled to the surgical instrument 35. Asused herein, the term “end-effectuator” is used interchangeably with theterm “effectuator element.” In some embodiments, the end-effectuator 30can comprise any known structure for effecting the movement of thesurgical instrument 35 in a desired manner.

FIG. 1C illustrates a portion of a surgical robot 15 with control of thetranslation and orientation of the end-effectuator in accordance withanother embodiment of the invention. As shown, some embodiments includea surgical robot system 1 capable of the utilization of a robot 15 withthe ability of moving the end-effectuator 30 along x-, y-, and z-axes(see 66, 68, 70 in FIG. 1C). In this embodiment, the x-axis 66 can beorthogonal to the y-axis 68 and z-axis 70, the y-axis 68 can beorthogonal to the x-axis 66 and z-axis 70, and the z-axis 70 can beorthogonal to the x-axis 66 and the y-axis 68. In some embodiments, therobot 15 can be configured to effect movement of the end-effectuator 30along one axis independently of the other axes. For example, in someembodiments, the robot 15 can cause the end-effectuator 30 to move agiven distance along the x-axis 66 without causing any substantialmovement of the end-effectuator 30 along the y-axis 68 or z-axis 70. Asused in this context “substantial” means a deviation of less than twodegrees from an intended path.

In some further embodiments, the end-effectuator 30 can be configuredfor selective rotation about one or more of the x-axis 66, y-axis 68,and z-axis 70 (such that one or more of the Cardanic Euler Angles (e.g.,roll, pitch, and/or yaw) associated with the end-effectuator 30 can beselectively controlled). In some embodiments, during operation, theend-effectuator 30 and/or surgical instrument 35 can be aligned with aselected orientation axis (labeled “Z Tube” in FIG. 1C) that can beselectively varied and monitored by the robot system 1.

In some embodiments, selective control of the translation andorientation of the end-effectuator 30 can permit performance of medicalprocedures with significantly improved accuracy compared to conventionalrobots that utilize, for example, a six degree of freedom robot arm 23comprising only rotational axes. For example, in some embodiments, asshown in FIG. 2, a surgical robot system 1 as depicted in FIGS. 1A-1C,can be used to operate on a patient, and the robot arm 23 that can bepositioned above the body of the patient 18, with the end-effectuator 30selectively angled relative to the z-axis toward the body of the patient18.

In some embodiments, the position of surgical instrument 35 can bedynamically updated so that surgical robot 15 can be aware of thelocation of surgical instrument 35 at all times during the procedure.Consequently, in some embodiments, the surgical robot 15 can move thesurgical instrument 35 to the desired position quickly, with minimaldamage to patient 18, and without any further assistance from aphysician (unless the physician so desires). In some furtherembodiments, the surgical robot 15 can be configured to correct the pathof surgical instrument 35 if the surgical instrument 35 strays from theselected, preplanned trajectory. In some embodiments, the surgical robot15 can be configured to permit stoppage, modification, and/or manualcontrol of the movement of the end-effectuator 30 and/or surgicalinstrument 35. Thus, in use, in some embodiments, a physician or otheruser can operate the system 1, and has the option to stop, modify, ormanually control the autonomous movement of end-effectuator 30 and/orsurgical instrument 35. Further details of the surgical robot system 1including the control and movement of a surgical instrument 35 by thesurgical robot 15 can be found in co-pending U.S. patent applicationSer. No. 13/924,505 from which this application claims priority under 35U.S.C. §120, and which is incorporated herein by reference in itsentirety.

In some embodiments, a guide tube 50 is used with a surgical instrument35 to operate on a patient 18. For example, some embodiments include aguide tube 50 comprising a distal end 50 a and a proximal end 50 b. Asused herein, “tube” is used to refer to somewhat hollow structures ofany one or more desired cross-sectional shapes. In some embodiments,when the surgical instrument 35 is advanced into the tissue of thepatient 18 with the assistance of a guide tube 50, the surgicalinstrument 35 can comprise a guide stop 52 that is configured to preventthe surgical instrument 35 from advancing when it reaches apredetermined amount of protrusion. For example, FIGS. 3A-3B eachillustrate a tool assembly 100 including a surgical instrument 35 havinga guide stop 52 in accordance with one embodiment of the invention. Asshown in FIG. 3B, when the guide stop 52 contacts the proximal end 50 bof the guide tube 50, the instrument 35 is prevented from extendingfurther. In some embodiments, by knowing the lengths of the guide tube50 and the surgical instrument 35, the distance between the respectiveends of the surgical instrument 35, and the location where the guidestop 52 is attached, it is possible to determine the maximum distancepast the end of the guide tube 50 that the surgical instrument 35 canprotrude (and therefore the length of extension and the location of thetip 35 c at the distal end 35 a relative to the guide tube distal end 50a during a procedure). In some embodiments, the instrument 35 can beguided by (and at least partially surround) or contact a guidestructure.

In some embodiments, it can be desirable to monitor not just the maximumprotrusion distance of the surgical instrument 35, but also the actualprotrusion distance periodically or at any instant during the insertionprocess. Therefore, in some embodiments, the robot 15 can periodicallyor substantially continuously monitor the protrusion distance, and insome embodiments, the distance can be displayed (e.g., such as ondisplay 29). In some embodiments, protrusion distance can besubstantially continuously monitored using a spring-loaded plunger 54including a compressible spring-loaded mechanism 55 a and sensor pad 55b that has a coupled wiper 56 (see for example FIGS. 4A-4D). In someembodiments, the guide stop 52 on the surgical instrument 35 can beconfigured to contact the spring-loaded mechanism 55 well before itencounters the proximal end of the guide tube 50. As shown in FIGS.4A-4D, by comparing the position of the surgical instrument 35 withinthe guide tube 50, in some embodiments, as the surgical instrument 35extends toward the distal end 50 a of the guide tube 50, the distal end35 a can approach the distal end 50 a of the guide tube (FIG. 4B).Further, as the surgical instrument 35 is moved further downwards (i.e.,the guide stop 52 moves toward the proximal end 50 b of the guide tube50), the distal end 35 a can extend outwards away from the distal end 50a of the guide tube (see FIG. 4C showing the extension of the distal end35 a and change in tip 35 c position after the stop 52 contacts theplunger 54, shown as region 36.) Further, as the surgical instrument 35is moved further downwards and the guide stop 52 contacts the guide tube50, the distal end 35 a can come to a stop, extending away from thedistal end 50 a of the guide tube 50 (see FIG. 4D, showing the change intip 35 c position (region 36.) As shown in FIGS. 4C-4D, as the guidestop 52 moves toward the proximal end 50 b of the guide tube 50, thecompressible spring-loaded mechanism 55 a within the spring-loadedplunger 54 can compress. One of ordinary skill in the art will recognizethat conversely, when the instrument 35 is moved back out of the guidetube 50, as the guide stop 52 moves away from the proximal end 50 b ofthe guide tube 50, the compressible spring-loaded mechanism 55 a withinthe spring-loaded plunger 54 can decompress from the compressed state.

In some embodiments, the tool assembly system 1000 (shown in FIG. 6B)can include a data input/output system including a sensor pad 55 bcoupled to a wiper 56. As shown, some embodiments include system 1000comprising at least one processor 1010 coupled to a network interface1040 including an application interface 1050. In some embodiments, theapplication interface 1050 is coupled to at least one operating system1020 and at least one enterprise application 1030. In some embodiments,the at least one processor 1010 can send and receive data from at leastthe network interface 1040 and the application interface 1050. Further,the network interface 1040 can be coupled to at least one computerreadable medium 1060 that in some embodiments can include data sources1060 a and data storage 1060 b.

In some embodiments, the surgical robot system 1 may be coupled to thetool assembly system 1000. In some other embodiments, the surgical robotsystem 1 may comprise the tool assembly system 1000. In someembodiments, the data input/output interface 1100 may be coupleddirected to the display 29 (e.g., to directly display from one or moresensors), and in other embodiments, the data input/output interface 1100may be coupled to the surgical robot system 1 or the display 29, orboth. In some embodiments, the data input/output interface 1100 mayinclude a conventional low voltage circuit coupled to one or moresensors 55 b, 56, 310, and 510. In other embodiments, the datainput/output interface 1100 may be coupled to a conventional low voltagecircuit coupled to one or more sensors 55 b, 56, 310, and 510. In someembodiments, the one or more sensors 55 b, 56, 310, and 510 may bepowered by the data input/output interface through a conventional lowvoltage circuit. In some other embodiments, the one or more sensors 55b, 56, 310, and 510 may be powered through a conventional low voltagecircuit and coupled to the data input/output interface.

In some embodiments, the at least one processor 1010 can receive datafrom at least one data input/output interface 1100. As depicted in FIG.6B, in some embodiments, the data input/output interface 1100 caninclude at least the sensor pad 55 a and coupled wiper 56. In someembodiments, when the wiper 56 moves across the position sensor pad 55b, its linear position is sampled by the tool assembly system 1000 andmay be processed using the at least one processor 1010. For example, insome embodiments, a calculation of the distance by which the surgicalinstrument 35 protrudes past the distal end 50 a of the guide tube 50may be processed substantially in real-time. For example, as shown inFIGS. 4A-4D, as the position of the surgical instrument 35 within theguide tube 50 is changed, as the surgical instrument 35 extends towardthe distal end 50 a of the guide tube 50, the wiper 56 can move towardthe distal end 50 a of the guide tube and across the sensor pad 55 bwithin the wiped region 58 (e.g., see the movement from FIG. 4B to FIG.4C). Further, as the surgical instrument 35 is moved further downwardstoward the distal end 50 a of the guide tube 50, and the guide stop 52contacts the guide tube 50 at the proximal end, the wiper 56 can movetoward the distal end 50 a of the guide tube 50 and across the sensorpad 55 b toward the lower end of the wiped region 58 (see FIG. 4D).

In some embodiments, as the wiper 56 moves across the sensor pad 55 btoward the lower end of the wiped region 58, the tool assembly system1000 can communicate the position of the wiper 56 and/or movement of thewiper 56 with respect to the sensor pad 55 b. As described earlier, insome other embodiments, the surgical robot system 1 may comprise thetool assembly system 1000, and the data input/output interface 1100 maybe coupled to the surgical robot system 1 to enable the surgical robotsystem 1 to read the wiper 56 position on the sensor pad 55 b, ormovement of the wiper 56 with respect to the sensor pad 55 b.

In some embodiments, the surgical instrument can comprise a drill bit42. Some embodiments include instruments 35 that enable the stop on adrill bit 42 to be manually adjusted with reference to markings 44 onthe drill bit 42. For example, FIGS. 5A-5C each illustrate tools formanually adjusting a drill stop 46 with reference to drill bit 42markings 44 in accordance with one embodiment of the invention. Further,FIGS. 5D-5F each illustrate tools for locking and holding a drill bit ina set position in accordance with one embodiment of the invention, andFIGS. 5G-5H each illustrate methods for use of the tools as depicted inFIGS. 5A-5F with a robot end effectuator 30 coupled to a surgical robotsystem 1. As shown, in some embodiments, the drill bit 42 can includecommercially available oppositely oriented one-way spring-loaded releasemechanisms 48 a, 48 b on each end of the drill stop 46. When not beingpulled against their spring, one-way release mechanisms prevent movementin one direction but allow free movement in the opposite direction. Forexample, in FIG. 5A, the resting release 48 a on the left side of thestop 46 allows the drill bit 42 to move freely through the release 48 afrom right to left but prevents movement of the drill bit 42 from leftto right. The release 48 b to the right of the stop 46 allows the drillbit 42 to move freely through the release 48 b from left to right butprevents movement from right to left. In some embodiments, when neitherrelease 48 a, 48 b is being pulled it is therefore not possible to movethe bit 42 in either direction. In some embodiments, if the release 48 aor 48 b on one end of the drill stop 46 is pulled, it is possible tomove the drill stop 46 up the shaft of the drill bit 42, away from thedirection of pull. In some embodiments, if the release 48 a or 48 b onthe other end of the drill stop 46 is pulled, it is possible to move thedrill stop 46 down the shaft (away from the direction of pull, see thedirection of movement in FIGS. 5B and 5C). The direction in which therelease 48 a, 48 b is pulled is opposite to the direction in whichmovement of the drill stop 46 is allowed so that accidental pulling ofone release 48 a, 48 b does not result in unintended movement of thedrill stop 46. For example, pulling the release 48 a toward the left inFIG. 5B allows the drill stop 46 to be moved toward the right. In someembodiments, if neither release mechanism 48 a, 48 b is pulled, thedrill stop 46 will not move in either direction, even if bumped.

Some embodiments include the ability to lock and hold the drill bit 42in a set position relative to the guide tube 50 in which it is housed.For example, in some embodiments, the drill bit 42 can be locked bylocking the drill stop 46 relative to the guide tube 50 using a lockingmechanism. FIGS. 5D-5H illustrates tools for locking and holding a drillbit 42 in a set position in accordance with one embodiment of theinvention. In some embodiments, the locking mechanism 49 shown in FIG.5F can comprise two clam shells 49 (shown in FIG. 5D). In someembodiments, a drill bit 42 can be locked into position by assemblingthe clam shells around the drill stop 46 (shown in FIG. 5E). Forexample, this feature allows the user to lock the drill bit 42 in aposition such that the tip slightly protrudes past the end of the guidetube 50 (see FIGS. 5G and 5H). In this position, the user can force theguide tube 50 to penetrate through soft tissues to force the guide tube50 to contact bone (for example during a percutaneous spine screwinsertion). Further details of the tools illustrated in FIGS. 5A-5G anddescribed above can be found in co-pending U.S. patent application Ser.No. 13/924,505 from which this application claims priority 35 U.S.C.§120, and which is incorporated herein by reference in its entirety.

In some embodiments, the tool assembly system 1000 can include the datainput/output interface 1100 with at least one position sensor 310. Insome embodiments, the at least one processor 1010 can send and receivedata from at least the network interface 1040 and the applicationinterface 1050 and may receive data from the data input/output interface1100 with at least one position sensor 310.

FIG. 6A illustrates a tool assembly 300 including a surgical instrument35 having a sensor enabled guide stop 52 in accordance with oneembodiment of the invention. As shown, in some embodiments, the surgicalinstrument 35 can include a magnetic strip 320 extending along someportion of the longitudinal length of the instrument 35, and thesurgical instrument 35 can include at least one position sensor 310. Theembodiment shown in FIG. 6A includes a magnetic strip 320 that extendsfrom a region substantially immediately adjacent to the guide stop 52,and extending to approximately three quarters of the length of thesurgical instrument 35.

In some other embodiments, the magnetic strip 320 may extend closer toor farther away from the distal end 35 a of the surgical instrument 35.As shown, in some embodiments, the magnetic strip 320 is positioned onthe outer surface of the surgical instrument 35. However, in some otherembodiments, the magnetic strip 320 can be positioned below the outersurface of the instrument 35 (i.e., the magnetic strip 320 may beembedded in the instrument 35). In some embodiments, the magnetic strip320 comprises a thickness that is sufficient to retain adequatemechanical integrity. For example, in some embodiments, the magneticstrip 320 comprises a thickness that is sufficient to retain adequatedurability during use, while having with enough magnetic field flux tobe detected by the position sensor 310.

In some embodiments, the magnetic strip 320 can comprise a thin,flexible, rigid or semi-rigid magnetic material with a thickness ofbetween about 0.001 and about 0.15 inches. In some embodiments, themagnetic strip 320 may be thinner than 0.001 inches, and in otherembodiments, the magnetic strip 320 may be thicker than 0.15 inches. Insome embodiments, the magnetic strip 320 comprises a self-supportingtape or similar material that can be cut to size and adhered to thesurgical instrument 35. In other embodiments, the magnetic strip 320 isformed on the surgical instrument 35 from a liquid or semi-liquid (e.g.,magnetic paint that is applied to the surface of the instrument 35 indefined locations which then dries to form the magnetic strip 320). Insome embodiments, the magnetic strip 320 comprises a ferrite-basedmagnetic material. In other embodiments, the magnetic strip 320comprises a rare-earth based magnetic material (e.g., a neodymium-basedpermanent magnet). In some further embodiments, the magnetic strip 320comprises an alnico-based magnetic material (i.e., analuminum-nickel-cobalt based magnetic material). For example, in someembodiments, the magnetic strip 320 can comprise a thin, flexible, rigidor semi-rigid magnetic strip 320 that comprises a material selected froma group consisting of ferrite-based magnetic material, a neodymium-basedpermanent magnet, an alnico-based magnetic material, and mixturesthereof. Alternatively, in some other embodiments, the magnetic strip320 is formed on the surgical instrument 35 from a liquid or semi-liquid(e.g., magnetic paint) that comprises a material selected from a groupconsisting of ferrite-based magnetic material, a neodymium-basedpermanent magnet, an alnico-based magnetic material, and mixturesthereof. In some embodiments, the magnetic strip 320 can be embeddedwithin the interior structure of the instrument 35. For example, it maybe positioned in the core of the instrument 35. In other embodiments, ifthe instrument 35 is tubular, the magnetic strip 320 can be placed onthe inside surface of the tubular orifice.

In some embodiments, the tool assembly 300 can include the positionsensor 310 coupled to the guide tube 51 a (see FIG. 6A). In someembodiments, the position sensor 310 can be a Hall-effect sensor capableof varying an output voltage in response to a magnetic field detectedfrom the magnetic strip 320. In some embodiments, the position sensor310 can comprise a magnetic sense-coil, or magneto-resistive read-head.In some embodiments, as the position sensor 310 moves with respect tothe magnetic strip 320, and magnetic fluctuation is detected, an outputsignal is generated by the data input/output interface 1100. In someembodiments, an insertion of the surgical instrument 35 in the guidetube 51 a can be detected using the position sensor 310. In someembodiments, the magnetic strip 320 can include a variable magneticfield flux capable of being detected by the position sensor 310 as itmoves with respect to the magnetic strip 320. For example, in someembodiments, the magnetic field flux of the magnetic strip 320 can riseand fall periodically through at least a portion of the longitudinallength of the magnetic strip 320. In the case of the position sensor 310being a Hall-effect sensor, this movement can produce a varying anoutput voltage in response to a magnetic field detected from themagnetic strip 320 as it moves from a region of low magnetic field fluxto a region of higher magnetic field flux.

In some embodiments, magnetic strip 320 can comprise alternativearrangements of regions of higher and lower magnetic field flux strengthcapable of being detected by the position sensor 310 as it moves withrespect to the magnetic strip 320. In some other embodiments, thealternative arrangements of regions of higher and lower magnetic fieldflux strength can comprise a magnetic bar code capable of being detectedby the magnetic strip 320 and processes using the at least one processor1010 through the data input/output interface 1100. In some embodiments,the arrangements of regions of higher and lower magnetic field fluxstrength can comprise a magnetic bar code (depicted as the magneticallycoded region 321 of the magnetic strip 320 shown in FIG. 6A). In someembodiments, as least some fraction of the magnetically coded region 321and can be capable of being detected by the magnetic strip 320 for thepurpose of identifying the surgical instrument 35. For example, in someembodiments, a surgical instrument 35 can include a magnetic strip 320that includes a magnetically coded region 321 with at least a type codeof the surgical instrument 35. Moreover, in some embodiments, thesurgical robot system 1 can include a safety protocol to perform a checkof the surgical instrument 35 prior to its use in a surgical procedure.In some embodiments, an insertion of the surgical instrument 35 in theguide tube 51 a for example, can be detected using the position sensor310 which can be capable of reading the magnetically coded region 321within the magnetic strip 320 as it passes the sensor 310. In someembodiments, information about the instrument 35 that will be insertedinto the guide tube 51 a can be stored magnetically and permanently orsemi-permanently in the magnetic strip 320 before surgery. Then, duringsurgery, when the tool is introduced in the guide tube 51 a, the sensor310 can read the magnetically coded region 321 of the strip 320 anddetect data regarding the tool's diameter, length, shape, or otherimportant information. These data can be automatically conveyed to theprocessor 1010 and displayed to the user via data input/output interface1100.

Some embodiments can include additional or alternative position sensors310. For example, FIG. 7A illustrates a surgical instrument 35 having aguide stop 52 in accordance with another embodiment of the invention. Asshown, the surgical instrument 35 can include three position sensors310, substantially equally spaced on the surgical instrument 35. In someembodiments, an insertion of the surgical instrument 35 in the guidetube 51 a can be detected using the position sensor 310, and themovement of the surgical instrument 35 within a guide tube 51 a can bedetected as it passes over the remaining position sensors (locatedapproximately half-way down the length of the surgical instrument 35 andadjacent the distal end 35 a of the surgical instrument 35). It shouldbe apparent to those of ordinary skill in the art that different lengthsof guide tube 51 a and instrument 35 can be assembled that necessitatedifferent numbers of position sensors 310 such that the magnetic strip320 is always adjacent to at least one sensor 310 at any longitudinalposition of the instrument 35 within the guide tube 51 a.

In some other embodiments, the tool assembly 400 (shown in FIG. 7C) caninclude an alternative guide tube 51 b including a longitudinal magneticstrip 420 and a radial magnetic strip 430. As used herein, “tube” isintended to cover circular and other shaped structures which may or maynot form a complete circle or other enclosing structure. For example,FIG. 7B is a modified guide tube 51 b for use with the instrument 35shown in FIG. 7A in accordance with one embodiment of the invention.FIG. 7C shows the tool assembly 400 including the instrument 35 shown inFIG. 7A inserted within the modified guide tube 51 b shown in FIG. 7B inaccordance with one embodiment of the invention. In some embodiments, aninsertion of the surgical instrument 35 in the guide tube 51 b can bedetected using the position sensor 310 using the longitudinal magneticstrip 420, and the movement of the surgical instrument 35 within a guidetube 51 b can be detected as it passes over the remaining positionsensors (located approximately half-way down the length of the surgicalinstrument 35 and adjacent the distal end 35 a of the surgicalinstrument 35) using the longitudinal magnetic strip 420. In someembodiments, a rotational movement of the instrument within the guidetube 51 a can be detected using the radial magnetic strip 430 as itmoves with respect to any one of the positions sensors 310. For example,in some embodiments, the tool assembly system 1000 can include the datainput/output interface 1100 with at least one position sensor 310. Theat least one processor 1010 can send and receive data from at least thenetwork interface 1040 and the application interface 1050, and mayreceive data from the data input/output interface 1100 with at least oneposition sensor 310 through an interaction with either the longitudinalmagnetic strip 420 or the radial magnetic strip 430. Therefore, in someembodiments, the surgical robot system 1 can detect at least themovement of the surgical instrument 35 longitudinally with respect theguide tube 51 b, and when the instrument 35 is twisting within the guidetube 51 b. In some other embodiments, the instrument 35 can be coupledto an exterior surface of a guide tube.

In addition to magnetic field based sensing, some embodiments includeoptical sensing of the movement of a surgical instrument 35 in a guidetube. For example, FIG. 8A illustrates a surgical instrument 35 having aguide stop 52 in accordance with another embodiment of the invention,and FIG. 8B illustrates a tool assembly 500 including a surgicalinstrument 35 having a guide stop 52 inserted within a modified guidetube 51 c in accordance with another embodiment of the invention. Asshown, in some embodiments, the surgical instrument 35 can include aplurality of high contrast markings 520 distributed along at least apartial longitudinal length of the instrument 35. In some otherembodiments, the plurality of high contrast markings 520 may extend oversubstantially the entirety of the longitudinal length of the instrument35.

In some embodiments, the modified guide tube 51 c can include at leastone optical sensor 510 capable of sensing at least one of the pluralityof high contrast marking 520. In some embodiments, as the surgicalinstrument 35 is inserted in the guide tube 51 c, the at least oneoptical sensor 510 can be capable of sensing at least one of theplurality of high contrast marking 520. Further, in some embodiments,the tool assembly system 1000 can include the data input/outputinterface 1100 coupled with at least one of plurality of high contrastmarking 520. The at least one processor 1010 can send and receive datafrom at least the network interface 1040 and the application interface1050 and may receive data from the data input/output interface 1100 withat least one of the plurality of high contrast marking 520, through aninteraction with the at least one optical sensor 510. Therefore, in someembodiments, the surgical robot system 1 can detect at least themovement of the surgical instrument 35 longitudinally with respect theguide tube 51 c as the optical sensor 510 detects at least one of theplurality of high contrast markings 520.

In some embodiments, the optical sensor 510 can be a photodiode, aphototransistor, a fiber-optic sensor, a photo-multiplier, a CCD, acamera or a combination of those described. In some embodiments, theoptical sensor 510 can detect ambient light reflected from the surgicalinstrument 35 including the plurality of high contrast marking 520. Inother embodiments, a conventional light source (e.g., an incandescentbulb or an LED light) can be used in combination with the optical sensor510 and high contrast marking 520, and the optical sensor 510 can detectlight emitted by the light source, reflected from the surgicalinstrument 35 including the plurality of high contrast markings 520.

Some embodiments can include an alternative optical recognition of asurgical instrument 35. For example, FIG. 9 illustrates a tool assembly600 including a surgical instrument 35 having a guide stop 52 insertedwithin a modified guide tube 51 c in accordance with another embodimentof the invention. As shown, in some embodiments, the surgical instrument35 can include an optically graduated coating 37. In some embodiments,the optically graduated coating 37 can include a graduation of coloracross at least a partial longitudinal length of the instrument 35. Insome other embodiments, the optically graduated coating 37 can include agraduation in light reflectivity across at least a partial longitudinallength of the instrument 35. For example, in some embodiments, theoptically graduated coating 37 can include a graduation in lightreflectivity extending from the proximal end (shown as a substantiallycolorless region adjacent the guide stop 52 in FIG. 9) to a darkerregion adjacent the distal end 35 a. In some embodiments, as thesurgical instrument 35 is inserted in the guide tube 51 c, the at leastone optical sensor 510 can be capable of sensing the coating 37.Further, in some embodiments, the tool assembly system 1000 can includethe data input/output interface 1100 coupled with the coating 37. The atleast one processor 1010 can send and receive data from at least thenetwork interface 1040 and the application interface 1050, and mayreceive data from the data input/output interface 1100 with at least oneof the plurality of high contrast marking 520, through an interactionwith the at least one optical sensor 510. Therefore, in someembodiments, the surgical robot system 1 can detect at least themovement of the surgical instrument 35 longitudinally with respect theguide tube 51 c as the optical sensor 510 detects the coating 37. Forexample, when the surgical instrument 35 is initially inserted into theguide tube 51 c, the optical sensor 510 may detect a low level of lightdue to the coating 37 comprising a dark color and/or a low reflectivity.As the surgical instrument 35 is further inserted into the guide tube 51c, the optical sensor 510 may detect an increasing level of light due tothe optical sensor 510 moving over a coating 37 comprising a graduallyincreasingly lighter color and/or a higher reflectivity

In some embodiments, the robotic surgical system 1 can comprise aplurality of tracking markers 720 configured to track the movement ofthe robot arm 23, the end-effectuator 30, and/or the surgical instrument35 in three dimensions. It should be appreciated that three dimensionalpositional information from tracking markers 720 can be used inconjunction with the one dimensional linear positional information fromabsolute or relative conventional linear encoders on each axis of therobot 15 to maintain a high degree of accuracy. In some embodiments, theplurality of tracking markers 720 can be mounted (or otherwise secured)thereon an outer surface of the robot 15, such as, for example andwithout limitation, on the base 25 of the robot 15, or the robot arm 23(see for example FIG. 1B). In some embodiments, the plurality oftracking markers 720 can be configured to track the movement of therobot 15 arm, the end-effectuator 30, and/or the surgical instrument 35.In some embodiments, the robotic surgical system 1 can utilize thetracking information to calculate the orientation and coordinates of thesurgical instrument 35 based on encoder counts along the x-axis 66,y-axis 68, z-axis 70, the Z-tube axis 64, and the roll 62 and pitch 60axes. Further, in some embodiments, the plurality of tracking markers720 can be positioned on the base 25 of the robot 15 spaced from thesurgical field 17 to reduce the likelihood of being obscured by thesurgeon, surgical tools, or other parts of the robot 15. In someembodiments, at least one tracking marker 720 of the plurality oftracking markers 720 can be mounted or otherwise secured to theend-effectuator 30 (see for example FIG. 1D). Further embodiments, atleast one optical marker of the plurality of optical tracking markers720 can be positioned on the robot 15 between the base 25 of the robot15 and the end-effectuator 30 instead of, or in addition to, the markers720 on the base 25 of the robot 15. In some embodiments, the positioningof one or more tracking markers 720 on the end-effectuator 30 canmaximize the accuracy of the positional measurements by serving to checkor verify the end-effectuator 30 position (calculated from thepositional information from the markers on the base 25 of the robot 15and the encoder counts of the z 70, x 66, y 68, roll 62, pitch 60, andZ-tube 64 axes). In some embodiments, the at least one tracking marker720 can be mounted to a portion of the robot 15 that effects movement ofthe end-effectuator 30 and/or surgical instrument 35 along the x-axis toenable the tracking marker 720 to move along the x-axis 66 as theend-effectuator 30 and surgical instrument 35 move along the x-axis 66(see FIG. 1D). In some embodiments, the placement of the trackingmarkers 720 as described can reduce the likelihood of a surgeon blockingthe tracking marker 720 from the cameras or detection device, or thetracking marker 720 becoming an obstruction to surgery.

In certain embodiments, because of the high accuracy in calculating theorientation and position of the end-effectuator 30 based on the trackingmarker 720 outputs and/or encoder counts from each axis, it can bepossible to very accurately determine the position of theend-effectuator 30. For example, in some embodiments, without requiringknowledge of the counts of axis encoders for the z-axis 70 (which isbetween the x-axis 66 and the base 25), knowing only the position of themarkers 720 on the x-axis 66 and the counts of encoders on the y axis68, roll axis 62, pitch 60, and Z-tube axes 64 can enable computation ofthe position of the end-effectuator 30. In some embodiments, theplacement of markers 720 on any intermediate axis of the robot 15 canpermit the exact position of the end-effectuator 30 to be calculatedbased on location of such markers 720 and counts of encoders on axes(66, 62, 60, 64) between the markers 720 and the end-effectuator 30.Further details of the surgical robot system 1 including the control,movement and tracking of the surgical robot 15 and of a surgicalinstrument 35 can be found in co-pending U.S. patent application Ser.No. 13/924,505 from which this application claims priority under 35U.S.C. §120, and which is incorporated herein by reference in itsentirety as earlier recited.

Some embodiments include one or more markers 725 coupled to the surgicalinstrument 35. In some embodiments, the markers 720, 725 can compriseconventional light-emitting diodes or an Optotrak® diode or reflectivePolaris sphere capable of being tracked using a commercially availableinfrared optical tracking system such as Optotrak®. Optotrak® is aregistered trademark of Northern Digital Inc., Waterloo, Ontario,Canada. In some embodiments, light emitted from and/or reflected by themarkers 720, 725 can be read by cameras 8200 used to monitor thelocation and movement of the robot 15 (see for example the camera 8200mounted on the camera arm 8210 and capable of movement through cameraarm joint 8210 a and camera arm joint 8210 b shown in FIG. 2). In someother embodiments, the markers 720, 725 can comprise a radio-frequencyand/or electromagnetic reflector or transceiver and the camera 8200 caninclude or be replaced by a radio-frequency and/or electromagnetictransceiver.

FIG. 10 illustrates a tool assembly 900 including a surgical instrument35 having at least one tracking marker 725 in accordance with a furtherembodiment of the invention. In some embodiments, a single marker 725can be adequate to determine the linear position of the instrument 35within the guide tube 50 if the guide tube 50 is tracked with a trackingarray 690. As depicted in FIG. 10, if this single tracking marker 725 iscoupled to the tool is offset from the longitudinal midline of the tool50, the marker's position in space relative to the guide tube 50 canprovide information about both the radial orientation and longitudinalposition of the instrument 35 within the guide tube 50. In some otherembodiments, a plurality of markers 725 can be used to determine thelinear position of the instrument 35 within the guide tube 50 if theguide tube 50 is tracked with a tracking array 690.

Although several embodiments of the invention have been disclosed in theforegoing specification, it is understood that many modifications andother embodiments of the invention will come to mind to which theinvention pertains, having the benefit of the teaching presented in theforegoing description and associated drawings. It is thus understoodthat the invention is not limited to the specific embodiments disclosedhereinabove, and that many modifications and other embodiments areintended to be included within the scope of the appended claims.Moreover, although specific terms are employed herein, as well as in theclaims which follow, they are used only in a generic and descriptivesense, and not for the purposes of limiting the described invention, northe claims which follow.

It will be appreciated by those skilled in the art that while theinvention has been described above in connection with particularembodiments and examples, the invention is not necessarily so limited,and that numerous other embodiments, examples, uses, modifications anddepartures from the embodiments, examples and uses are intended to beencompassed by the claims attached hereto. The entire disclosure of eachpatent and publication cited herein is incorporated by reference, as ifeach such patent or publication were individually incorporated byreference herein. Various features and advantages of the invention areset forth in the following claims.

1. A guided surgical tool assembly comprising: a guide tube including at least one sensor; a surgical instrument moveable with respect to the guide tube, the surgical instrument including at least one detectable feature; and wherein the at least one sensor is configured and arranged to detect the at least one detectable feature when the surgical instrument is at least partially coupled with the guide tube.
 2. The guided surgical tool assembly of claim 1, wherein the detectable feature comprises a magnetically detectable feature capable of generating a magnetic flux field; and wherein the sensor is a position sensor capable of detecting the magnetic flux field.
 3. The guided surgical tool assembly of claim 1, wherein the position sensor is a magnetic flux field sensor selected from a group consisting of a ferrite-based magnetic material, a rare-earth based magnetic material, an aluminum-nickel-cobalt based magnetic material, and mixtures thereof.
 4. The guided surgical tool assembly of claim 2, wherein the position sensor is configured and arranged to detect insertion into and movement of the surgical instrument in the guide tube by sensing the magnetically detectable feature.
 5. The guided surgical tool assembly of claim 1, wherein the detectable feature includes at least one longitudinal magnetic strip and at least one radial magnetic strip.
 6. The guided surgical tool assembly of claim 5, wherein the guide tube includes at least two position sensors.
 7. The guided surgical tool assembly of claim 6, wherein the at least two position sensors are configured and arranged to sense a magnetic field flux from the longitudinal magnetic strip or the radial magnetic field strip or both.
 8. The guided surgical tool assembly of claim 7, wherein a longitudinal position of the surgical instrument in the guide tube can be at least partially determined using a measurement of a magnetic field flux from the longitudinal magnetic strip.
 9. The guided surgical tool assembly of claim 7, wherein a radial position of the surgical instrument in the guide tube can be at least partially determined using a measurement of a magnetic field flux from the radial magnetic strip.
 10. The guided surgical tool assembly of claim 1, wherein the detectable feature comprises an optically detectable feature; and wherein the at least one sensor comprises at least one optical sensor.
 11. The guided surgical tool assembly of claim 10, wherein the optically detectable feature comprises a high contrast marking distributed along at least a partial longitudinal length of the guided surgical tool assembly.
 12. The guided surgical tool assembly of claim 11, wherein the at least one optical sensor comprises a light sensitive detector selected from a group consisting of a photodiode, a phototransistor, a fiber-optic sensor, a photo-multiplier, a CCD, a camera, or a combination thereof.
 13. The guided surgical tool assembly of claim 11, wherein a longitudinal position of the surgical instrument in the guide tube can be at least partially determined by optically sensing light from the high contrast marking using the at least one optical sensor.
 14. The guided surgical tool assembly of claim 10, wherein the optically detectable feature comprises a graduated coating distributed along at least a partial longitudinal length of the guided surgical tool assembly.
 15. The guided surgical tool assembly of claim 14, wherein the graduated coating comprises a graduated reflective coating.
 16. The guided surgical tool assembly of claim 14, wherein the graduated coating comprises a graduated color coating.
 17. The guided surgical tool assembly of claim 14, wherein a longitudinal position of the surgical instrument in the guide tube can be at least partially determined by optically sensing light from the graduated coating using the at least one optical sensor.
 18. The guided surgical tool assembly of claim 1, wherein the guide tube comprises a distal guide tube end and a proximal guide tube end; and the surgical instrument includes a distal end and a proximal end; and wherein the sensor comprises at least one sensor pad; and wherein the guided surgical tool assembly further comprises: a guide stop coupled to the proximal end of the surgical instrument; and a plunger mechanism including a compressible spring mechanism coupled to the distal end of the guide tube and a wiper configured and arranged to be sensed by the at least one sensor pad.
 19. The guided surgical tool assembly of claim 18, wherein longitudinal movement of the surgical instrument within the guide tube where the guide stop moves toward the proximal end of the guide tube can at least partially compress the spring and move the wiper with respect to the at least one sensor pad.
 20. The guided surgical tool assembly of claim 18, wherein longitudinal movement of the surgical instrument within the guide tube where the guide stop moves away from the proximal end of the guide tube can at least partially decompress the spring and move the wiper with respect to the at least one sensor pad.
 21. A guided surgical tool assembly system comprising: a tool sensor system including at least one processor and at least one data input/output interface, the data input interface including at least one sensor; a guide tube including the at least one sensor; a surgical instrument moveable within the guide tube, the surgical instrument including at least one detectable feature; and wherein the at least one sensor is configured and arranged to detect the at least one detectable feature.
 22. A guided surgical tool assembly system of claim 21, wherein the guide tube comprises a distal guide tube end and a proximal guide tube end; and the surgical instrument includes a distal end and a proximal end; and wherein the sensor comprises at least one sensor pad; and wherein the guided surgical tool assembly further comprises: a guide stop coupled to the proximal end of the surgical instrument; and a plunger mechanism including a compressible spring mechanism coupled to the distal end of the guide tube and a wiper configured and arranged to be sensed by the at least one sensor pad; and wherein the at least one processor is configured and arranged to detect the at least one surgical instrument when at least partially inserted or moved in the guide tube.
 23. The guided surgical tool assembly system of claim 21, wherein the detectable feature comprises a magnetically detectable feature capable of generating a magnetic flux field; and wherein the sensor is a position sensor capable of detecting the magnetic flux field; and wherein the position sensor is configured and arranged to detect insertion into and movement of the surgical instrument in the guide tube by sensing the magnetically detectable feature.
 24. The guided surgical tool assembly system of claim 21, wherein the detectable feature comprises an optically detectable feature; and wherein the at least one sensor comprises at least one optical sensor; and wherein the optically detectable feature comprises a high contrast marking distributed along at least a partial longitudinal length of the guided surgical tool assembly.
 25. The guided surgical tool assembly system of claim 21, wherein the detectable feature comprises an optically detectable feature; and wherein the at least one sensor comprises at least one optical sensor; and wherein the optically detectable feature comprises a graduated coating distributed along at least a partial longitudinal length of the guided surgical tool assembly.
 26. A guided surgical tool assembly system of claim 21, wherein the surgical instrument includes at least one tracking sensor.
 27. A medical robot system, comprising; a robot coupled to an effectuator element, the robot configured for controlled movement and positioning; a motor assembly coupled to the robot, the motor assembly being configured to move the effectuator element along one or more of an x-axis, a y-axis, and a z-axis such that movement of the effectuator element along one of the x-, y-, or z-axes occurs independently of movement of the effectuator element along the other axes of the x-, y-, and z-axes, wherein the x-axis is substantially perpendicular to the y- and z-axes, the y-axis is substantially perpendicular to the x- and z-axes, and the z-axis is substantially perpendicular to the x- and y axes; a tool sensor system including at least one processor and at least one data input/output interface, the data input interface including at least one sensor; a guide tube including the at least one sensor; a surgical instrument moveable with respect to the guide tube, the surgical instrument including at least one detectable feature; and wherein the at least one sensor is configured and arranged to detect the at least one detectable feature; and wherein the at least one processor is configured and arranged to detect when the surgical instrument is at least partially coupled with the guide tube.
 28. A medical robot system of claim 27, wherein the surgical instrument includes at least one tracking sensor. 